Hospital security: Strengthening the weakest link

It is estimated there are two security officers for every police officer in America. How well they support one another to provide security for a prisoner receiving medical care in a private hospital is determined by a number of factors, including the security officer’s training, experience, administrative support, state and local laws — not to mention the individual attitudes of both security and police officers.

Unlike a sworn officer, a security officer’s level of training, standards and compensation package varies widely. The need for a high level of competency for public safety personnel is no more apparent than it is in the treatment setting. And while some of the best trained and supported security officers are found in hospitals, many facilities have some catching up to do.

There are far too many inadequately trained and equipped security officers and psychiatric custodial staff maintaining care and custody of forensic prisoners and the cognitively impaired or emotionally disturbed persons.

Closing the gapTraditionally, the courtroom has been considered the weakest link in the chain of prisoner custody. But that isn’t so. The weakest link in prisoner custody is a hospital. Why? Because healthcare is the one public service that prisoners to which prisoners have access: When an inmate needs a haircut he goes to the prison barber shop, but if he needs an MRI he goes to the same hospital your family goes to.

It seems everyone in healthcare has firsthand experience with escapes, assaults and even the occasional tragedy involving forensic patients.

Forensic patientsForensic patients are best classified into four categories: Medical clearance, police hold, police custody, and emergency detention. The following four examples comprise the majority of forensic patients who interact with the general public every day in hospitals. When not handled properly, they represent a significant threat to public safety:

The first stop on the way to jail is often an emergency room for medical clearance. Prisoners have to be certified as medically stable before they can be admitted into most jails.

Many hospitals also have to deal with police hold patients. These are usually inpatients that police have an interest in talking to, once their medical condition has stabilized. The hospital staff is asked to call the requesting agency once the patient is ready for discharge.

Police custody patients are inpatients who are under arrest or sentence. They have a police or corrections officer assigned to maintain physical custody.

Lastly, emergency detention patients are those who a clinician believes are a threat to themselves or others. These patients have to be safely managed until the police arrive to take responsibility for them.

Hospitals need sound policies, procedures, and training to support their staff in the handling of forensic patients. How agencies request services for their prisoners and how healthcare facilities work together is mostly a function of what the institution insists upon.

We've all heard the storiesRecently, while conducting onsite training at an acute care hospital, I encountered an example of a mishandled forensic patient involving a police officer assigned to a police custody patient.

The officer maintaining custody of an inpatient fell asleep. A nurse woke him and then returned to her normal duties. When the officer fell asleep again, the prisoner removed the handcuff key from the officer’s shirt pocket and slipped quietly away.

The fact is, I’ve heard stories like this at every facility where I’ve ever trained.

What’s the solution? Hospitals must require their own security department to liaison with all agencies that maintain custody of patients inside their facility in order to assess any related security risks — and offer appropriate support.

In this case, the prisoner had to be switched to non-metallic restraints for an MRI scan. During the process, the inmate disarmed and killed the officer. University of Utah Medical Center now requires that prisoners brought in for procedures be accompanied by two officers.

The takeaway lesson of that tragedy is that police agencies don’t necessarily have the last word when it comes to safety on private (or even public) property.

Caregiver responsibility and trainingHospitals should run a risk assessment on police hold patients prior to intake. Hospitals are responsible for all of their patients, and as such, have every right to ask how much of a danger a given patient presents to their facility, and whether they should insist on a higher level of security.

Healthcare security officers should continuously evaluate the status of forensic patients throughout their shift. All information on these patients should be passed on to relieving shifts. If possible, methods of tracking and flagging forensic prisoners should be integrated into the registration process. Nursing staff should report any concerns or suspicious activities involving their forensic patients.

At Children’s Hospital and Health System, we have instituted a program of violence management and patient restraint, based on the Wisconsin Principles of Subject Control (POSC®) and Interventions for Patients with Challenging Behaviors Training Programs.

The programs are immensely popular with participating nursing and medical staff. Part of the training they receive involves the handling of forensic patients. The program is growing beyond its original scope; we are receiving requests for training from other treatment facilities, social service agencies and even police departments.

Care providers are also trained not to discuss their patient’s legal matters with them. Patients who are on police hold may not be fully aware of their status. Many incidents involving police hold patients running have occurred simply because a care provider advised them, “You’re better now, time to call the police!”

Families and attorneys will even try to communicate to a police custody patient via a care provider, requesting they pass on information or legal advice. Such a relationship can get a nurse or doctor into all sorts of difficulty.

We also give care providers a basic understanding of handcuffs and other police restraints, specifically, how they work and why they are used. Escape attempts from hospitals emergency rooms have, for one reason or another, often occurred after a prisoner was un-cuffed.

Some of the reasons I’ve been asked to un-cuff a patient are:

“They look uncomfortable”;

“I need to start an I.V. (that it turned out could be started elsewhere)”; and

“He doesn’t look like he could hurt a fly.”

Patient care staff should never ask an officer to remove handcuffs or other restraints, unless a bona fide medical reason can be documented in the patient’s chart — and only after alternative measures have been taken to maintain the safe custody of the prisoner.

Security officers could respond to assist the police officer during the procedure, and better yet, respond with alternative restraint equipment.

Tragic hospital escapes: the broken recordAll too frequently, people are hurt or killed by prisoners escaping from hospitals.

On August 20, 2006, inmate William Morva feigned illness to get inside Montgomery Regional Hospital, in Blacksburg, VA, located next to the ill-fated Virginia Tech campus, where eight months later the worst campus shooting in U.S. history would occur. Morva bragged to another inmate that he was faking illness to go to the ER, where he could easily escape.

Unfortunately, he made good on his boast. Morva disarmed and seriously wounded the lone Montgomery County Sheriff’s Deputy who was escorting him. When Security Officer Derrick McFarland responded to shots fired, Morva shot and killed him with the deputy’s gun.

Prior to his recapture Morva claimed one last victim, Sheriff’s Corporal Eric E. Suphtin, who was shot and killed while searching for Morva along the wooded trails surrounding the campus.

Tactical training and awarenessAnother thing we can learn from tragedies like these is that cops always bring weapons to the scene: Guns, Tasers, OC spray, batons and even knives. When healthcare security officers back a cop up, they enter a scene rife with weapons. Even unarmed heathcare security personnel need to receive training in weapons retention and control, and all healthcare staff should be versed in tactical awareness.

Police and treatment professionals can work together to ensure that hospitals can effectively treat society’s prisoners without risking public safety.

Children’s Hospital of Wisconsin and the Milwaukee County Sheriff’s Office are a great example of cooperation between public and private institutions. The Sheriff’s Training Academy offers their facilities and equipment for Children’s officers to train and certify as POSC® and Interventions for Patients with Challenging Behaviors Instructors.

Other Milwaukee Regional Medical Center Campus partners, like the Medical College of Wisconsin, have also trained their public safety officers in Defensive and Arrest Tactics® at the MCSO Training Academy.

The Milwaukee County Sheriff’s Office has a long-standing tradition of cooperation with hospitals and treatment centers, fostered by trainers like Captain Peter Jaskulski, the current academy director. There is also a long-standing tradition of MCSO deputies assigned to the MRMC campus to support the various public safety assets of each of its diverse institutions.

By enhancing cooperation between medical facilities and local police agencies, we can effectively close what has become the weakest link in prisoner custody.

About the author

Joel Lashley has worked as a public safety professional for 25 years, including 17 years of service in the health care setting. Joel leads the training program for hospital, clinical, and social outreach staff in Violence Awareness, Prevention, and Management at Children’s Hospital of Wisconsin in Milwaukee, the only level 1 pediatric trauma center in the region, serving critically injured and ill patients throughout the Mid-West
He has trained hundreds of nursing, clinical, social work, psychiatric, and public safety professionals in the management and prevention of violence. He is a certified instructor for Interventions for Patients with Challenging Behaviors and Principles of Subject Control (POSC®) – Security Personnel, and Non-violent Crisis Intervention®, from the Crisis Prevention Institute. He is a member of the International Association for Healthcare Security and Safety and the International Association of Non-violent Crisis Intervention Certified Instructors.
Joel has developed a program for managing the care of children, adolescents, and adults with autism and other cognitive disabilites. The fact that his son has autism has made him concerned about how this segment of our population is managed in the medical, security, and law enforcement arenas. Future articles deal with this and other issues facing our medical and mental health facilities as we search for ways to best treat their patients.

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